Provider Demographics
NPI:1184020323
Name:MASON, SCOTT C (DDS)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:C
Last Name:MASON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BX 1058
Mailing Address - Street 2:132 W. WASHINGTON
Mailing Address - City:AVA
Mailing Address - State:MO
Mailing Address - Zip Code:65608-1058
Mailing Address - Country:US
Mailing Address - Phone:417-683-3636
Mailing Address - Fax:
Practice Address - Street 1:132 W WASHINGTON
Practice Address - Street 2:
Practice Address - City:AVA
Practice Address - State:MO
Practice Address - Zip Code:65608-1058
Practice Address - Country:US
Practice Address - Phone:417-683-3636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-17
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0134381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice